Table 3 Emotional toll subthemes and exemplar quotes

Impact on the individual

“I think that there was a lot of especially because COVID is hitting kind of racial and socio-economic groups and ethnic groups very differently. So, I felt like when I talked to my colleagues, they were sensing that a lot, like, you know, taking care of Nepalese families, and like, the whole family is hospitalized and like the two kids are at home. So, they're trying to figure out obviously, how to care for these patients, but also dealing with that burden and the stress and the moral distress you have of like seeing these health inequities in your face.” (MD/DO, Interview/FG 24)

“I think clinically, like it was just such an unknown. There’s so much like fear stuff in the media and so you’re trying to stay informed, but I would – I couldn’t listen to the news driving into work because it would just get me stressed out like before I got here. So I think it was kind of interesting, thinking like wanting to stay in touch but then not wanting to let it get into you mentally before you come here and try and care for patients.” (APP, Interview/FG 6)

“Nobody, nobody I've talked to in the city or in other states did have face respirators for their providers. Like, literally nobody. And from my perspective, I appreciated that, especially early on, because I had, I felt like I knew that no matter what happened, I had the equipment that I needed.” (MD/DO, Interview/FG 1)

“This was so hard for everybody, I mean, I walk on those units, and the battle fatigue with the doctors and nurses and then the social workers and-and care managers as well. Um, I don't know what the answer is to that to kind of help us do better with the battle fatigue, but that all of those things, I think, just really took a toll.” (Care Management, Interview/FG 8)

“I mean I really have to push through it. At the beginning I was super afraid. I even told my husband, "I don't know if I'm going to get out of this. I may get infected and I will die within the field.” (MD/DO, Interview/FG 21)

Impact on personal life/family

“I think that overarching stress, and then repeatedly having to go into an environment where you were, you know, being exposed, and then potentially exposing your family. And then experiencing, the medical care system in this new, dynamic environment. And not really being able to fully express that to a spouse who—who isn't experiencing it. I think was a little bit challenging and I think—I mean I think that universally would be true. It's kind of like going to med school. You can talk about it, but you can't fully explain—you can tell somebody who has been through it, they don't really know—know what that is like.” (MD/DO, Interview/FG 26)

“It was tricky, because I mean personally, our family was newly pregnant during that time. And so I was like, “Oh, should I go to the ICU? Because there's a pregnant patient in ICU.” It's like, not looking so hot right now, and is this what happens to pregnant people? So there was just a lot of worry there…” (Interview)^a